The interesting reading of the excellent articles by Pathak et al. (1,2) triggered us to retrospectively review a cohort of 1,068 consecutive patients with atrial fibrillation (AF), to evaluate whether the correlation between body mass index (BMI) and AF behavior could also be verified in an unselected group of Mediterranean patients, being that, to the best of our knowledge, such information is still unreported.

Among 653 patients referred between 2005 and 2014, 258 patients with the following data available were included: electrocardiographic (ECG) documentation of paroxysmal or persistent AF, initial and follow-up BMI data, reliable ability to report AF-related symptoms, exhaustive clinical history, guidelines-consistent (3) treatment, and at least 3 reassessments during a minimum 6-months follow-up period. Exclusion criteria were the same as in LEGACY (Long-Term Effect of Goal Directed Weight Management on Atrial Fibrillation Cohort: A 5 Year Follow-Up Study). According to BMI and its variation during follow-up, patients were stratified into 4 groups, as follows: Group 1 (n = 42, baseline BMI <25 kg/m2 and unchanged during the follow-up); Group 2 (n = 81, BMI >25 kg/m2 and losing 2 or more units during the follow-up); Group 3 (n = 73, with BMI >25 kg/m2, unchanged during the follow-up); Group 4 (n = 62, BMI >25 kg/m2 and gaining 2 or more units during the follow-up). All were encouraged to keep/reach BMI ≤25 kg/m2 with diet and/or moderate exercise. Overall follow-up was 602 patient-years. ECG-documented AF recurrences were most frequent in Group 4 patients, with a significant correlation between BMI behavior and the time interval between subsequent recurrences (every 2.6 months [Group 4], 5.5 months [Group 3], 13.7 months [Group 2], and 15.2 months [Group 1]). Therefore, we can confirm that BMI reduction has a preventive effect against AF recurrence and that the LEGACY study results can be applied also to Mediterranean patients. In addition, we found that the clinical outcome of AF can be further improved, with similar incidence of comorbidities, if the target BMI reduction is higher (average 5.6 U, in our population).

Footnotes

Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Toolbox

Thank you for your interest in spreading the word about JACC: Journal of the American College of CardiologyNOTE: We request your email address only as a reference for the recipient. We do not save email addresses.

Your Email *

Your Name *

Send To *

Enter multiple addresses on separate lines or separate them with commas.